According to the International Food Information Council Foundation’s 2018 Food and Health Survey, the vast majority of patients (78%) who seek dietary information from their physicians change their eating habits as a result of these conversations 14. Doctors should therefore be familiar with evidence-based nutritional recommendations and educate their patients accordingly. Yet, few physicians feel sufficiently prepared to counsel patients about their diet 19,20. A major reason for this is that dedicated nutrition training in medical school is both limited in scope and impractical; it is often virtual lecture-based and thus detached from the real-life skills necessary to prepare nutritious meals and counsel patients. Moreover, even when physicians are educated in nutrition, as they are at the medical school serving as the site of this study, there still frequently exists a knowledge gap in how to apply that knowledge to achieve a healthy diet. To fill these gaps, we tested an interactive, practical, skills-based intervention for medical students designed to improve their knowledge of and confidence with nutrition basics and culinary skills. The ultimate goal of this intervention was to better prepare future physicians to effectively counsel their patients on food and nutrition.
Similar to the findings of Hicks and Murano19 and Vetter et al.20, we found that our medical student participants did not feel highly prepared to effectively counsel patients on how to practice a healthy lifestyle pre-intervention: no respondents rated themselves a 7 out of 10 or higher when asked to self-assess their preparation in the baseline survey. However, after the intervention, participants’ self-rated preparedness to counsel patients on a healthy lifestyle was significantly higher. Ninety percent of respondents rated themselves to be a 7 out of 10 or higher on this item in both the immediately post-intervention and two months post-intervention surveys, which also reveals the durability of the active learning course’s effects. There were simultaneous increases in participants’ perceptions that they had the medical, nutritional, and culinary knowledge necessary to effectively counsel patients.
Participants’ perception of increased knowledge was mirrored in tests of their objective culinary knowledge, which also increased post-intervention compared to pre-intervention. Despite a decline in objective culinary knowledge at two months post-intervention compared to immediately post-intervention, participants’ objective culinary knowledge two months post-intervention was still higher overall than before they took the course.
In summary, we show that an interactive culinary nutrition course for medical students can improve their culinary knowledge and their confidence in counseling patients about food and nutrition. We find evidence that these improvements can be retained over time, even after a relatively small-scale (8-hour), short-term intervention such as this. We attribute the success of this intervention in large part to its practical and interactive nature, which the literature also finds to be the most effective method of nutrition education 33,34.
Our study has a number of limitations. Primarily, we ran a small, non-randomised, uncontrolled intervention. Although statistical analyses were done specifically to assess within-person change, replication of this intervention with a larger sample size would afford greater statistical power and further confirmation of this study’s results. A controlled study with randomised assignment to the intervention should also be established to remove the possibility of self-selection bias. Recall bias and social desirability bias may also have impacted the results. A larger bank of culinary knowledge test questions should be developed and randomised to participants at each of the timepoints to minimise the potential that recall bias contributes to the score increase observed between the objective pre- and post-intervention assessments. Finally, although the surveys were fully anonymous, participant self-reporting may over-report learning and/or under-report remaining doubts if participants felt the desire to “pay back” the instructor and principal investigator, N.I. Wood, with such reviews. Of note, this limitation is somewhat mitigated by the objective assessment of culinary knowledge included at every survey timepoint.
Implications for Future Research and Practice
Practical culinary nutrition interventions can build on the curriculum used here in a number of ways. Delivering this curriculum to an entire medical school class will be challenging. However, amid the growing landscape of remote learning and video conference calls brought on by the coronavirus disease 2019 (COVID-19) pandemic, we are confident that online or hybrid versions of this course could be piloted as an efficient means of scaling up the curriculum. What is most important is to see the impact of the curriculum and hands-on experience on the counseling behavior of medical students. Therefore, future research should assess the impact of this intervention on the frequency and/or quality of nutrition counseling provided. Such efforts should be paired with ongoing research to further refine the pedagogical approaches that best prepare physicians to help their patients follow a healthy diet. Further research will also be necessary to determine what effect, if any, a practical culinary nutrition course for physician trainees has on the overall healthiness of participants’ diets.